Systems and processes for forming anatomical features in dentures

ABSTRACT

The system of a preferred embodiment uses a process whereby a true replication of the patient&#39;s jaw structure is created in a digital three dimensional model. This true replication is then used to precisely locate and/or copy the anatomical landmarks of the patient for use in fabricating a denture base for use in a denture for the individual patient. This system is able to to create a denture with precisely located features corresponding to the anatomical landmarks of the patient with little manual intervention.

FIELD OF THE INVENTION

This invention relates to the field of manufacturing of dentures andparticularly forming anatomical and functional features in dentures.

BACKGROUND

Dentures need to be closely fitted to anatomical landmarks on thepatient in order for the denture to comfortably fit as well as to beunder the neuromuscular control of the patient. It is critical for thedentures to properly fit in order for the dentures to be worncomfortably and securely without the embarrassment of falling out duringuse.

The anatomical landmarks are typically located relative to the patient'sanatomy by using a customized denture impression tray. Thermoplasticmolding compound is applied along the peripheral edges of the tray whichis positioned in the patient while the compound is soft. The patientmanipulates their jaw while the compound is setting to provide in theimpression appropriate clearances within the buccal, labial and/orlingual folds. This process is uncomfortable for the patient and doesnot provide precise location of the anatomical features. The resultingimpressions are typically used in creating a wax rim. The wax rim istried in the patient and marked to provide areas which need to be carvedfor a better fit. This requires skill on the part of the dentist andtechnicians.

One critical area of fit for the denture is the post dam. The post damon a denture is a ridge along the back of the denture which pressesslightly into the posterior palate to form a seal. The increasedthickness of the denture along a narrow border adds pressure on thetissue and maintains a vacuum seal. Without this sealing effect, theupper denture the vacuum between the denture and the roof of the mouthis reduced or lost and the denture loosens as the wearer talks, chews orswallows. This seal is critical for the upper denture to be secure inthe patient.

The ideal location for the post dam is along the junction of the hardand soft palates. The junction between the hard and soft palate wherethe denture border lies is neither a straight line nor of uniformconsistency. It is harder in the midline and soft on both sides of themidline. Thus, an ideal post dam has to reflect the anatomy and featuresof that pa.tt of the mouth. If the denture extends too far to the rearof the mouth, the patient may suffer from gagging. If the dentureextends too much into the hard palate, the denture will likely lose thevacuum seal and will not fit

Currently, the post dam is created on the denture by modifying theimpressions or by application of a wax material to the area of theplaster model representing the roof of the mouth. Both require the useof a plaster model of the denture upon which the post dam is carved by atechnician based on the estimation of where the line between the hardand soft palate occurs in the impression into the mold from the denturewill be fabricated. Both techniques are less than precise in locatingthe ideal position. Thus the precision on where the post dam is locateddepends upon the quality of the impressions and the skill of thetechnician.

Another set of anatomical feature that are critical for the proper useof dentures are the labial and buccal frenae. The labial frenum attachesto the center of the upper lip and between the upper two front teethwhile the buccal frenums attach the alveolar ridge to the cheek on eachside of the mouth. If the matching notches of the denture are notlocated precisely for the labial frenum and the buccal frenums, thedenture can often be pulled loose. Currently these frenums are visuallylocated by the dentist or technician and the notches formed by a file inthe impressions.

The rugae is typically neglected in the creation of dentures. Thepalatial rugae is asymmetrical and has irregular elevations of themucosa located in the anterior third of the palate. Each individual hasa unique rugae which can affect the speech of the individual. Currently,most dentures do not include a rugae and are smooth, instead. In thoseinstances where a denture does include a rugae, the rugae is typicallyformed from a template rather than having a unique rugae for eachpatient.

Thus, presently there is no process for creating dentures that have theprecise fit to or mimicking of the anatomical features of the patientsmouth.

SUMMARY OF THE INVENTION

The present invention provides systems and processes for creatingdentures that have features precisely located and formed to provide aclose comfortable fit for the dentures in the patient. These featuresprovide critical functional and aesthetic improvement for the fit andcomfort of the patient. The system of a preferred embodiment uses aprocess whereby a true replication of the patient's jaw structure iscreated in a digital three dimensional model. This true replication isthen used to precisely locate and/or copy the anatomical landmarks ofthe patient for use in fabricating a denture base for use in a denturefor the individual patient.

The term denture base generally refers to the part of a denture thatfits the oral mucosa of the basal seat, restores the normal contours ofthe soft tissues of the edentulous mouth, and supports the artificialteeth. The term denture refers to the denture base with the artificialteeth attached. The term anatomical landmarks refers to the structureson the anatomy of the wearer that define the periphery of the denture.The term anatomical features includes the features corresponding to theanatomical landmarks of the wearer as well as aesthetic and functionalfeatures that are created in the denture.

One anatomical landmark that is determined preferably by the system, butalternatively by a technician using the system is the line between thehard and soft palates. This line is irregular and difficult to determineprecisely using current techniques. One preferred embodiment of thepresent invention determines this line from the digital model. Once thisline is determined, a post dam is created on the digital model.

Another set of anatomical landmarks that are determined are the labialfrenum and the buccal frenums. The precise location of the frenums in apreferred embodiment is identified so that notches matching thesefrenums are precisely located and shaped in the denture base. Thisminimizes dislocation of the denture during speech and improves thecomfort, fit and aesthetics of the denture.

Another preferred embodiment accentuates the buccal reflection of thepatient. This accentuation is called the buccal roll. The buccal rollfor purposes of this patent is defined as the small rounded ridge thatis added to the denture to improve vacuum adherence, goes from theanterior middle back to the most posterior points on the outer margin.From this precise location of the buccal roll, a slight undercut can beformed in the denture base. The tissues and muscles surrounding thebuccal roll will engage into the undercut to form a gripping region tofurther secure the denture.

The system of a preferred embodiment is able to precisely locate themargin, or trim line along the buccal reflection. This reduces the timefor technician to carve or trim the denture base after molding andimproves the comfort. This line can also be registered by the system tobe included into the digital denture model and on the denture base.

Another embodiment of the present invention determines the soft tissuelines from the digital model so that they can be registered and includedinto the denture base for fabrication. In particular, the gingivalmargin where the gum ends on the teeth and the soft tissue surroundingthe roots of the teeth below the gum are mimicked on the denture base.These soft tissue lines are largely for aesthetic reasons but also mayimprove the comfort to the patient.

One unique feature of a preferred embodiment is able to create the rugaeof the individual patient for use in the denture base. The rugae iscopied on the tissue side and mimicked on the teeth side. The rugae canalso be accentuated or diminished as needed to improve the speech orcomfort of the patient. Each rugae is unique to an individual and affectthe speech and comfort of the individual. The rugae is also used toidentify individuals for forensic purposes. The rugae is registered bythe system for copying into the digital denture base model for selectionor fabrication in the denture base.

The system of a preferred embodiment may also be used to select areas ofthe denture base that may be selectively thinned or thickened. Thisthinning or thickening may be done across the arch of the denture base,along the palatial region of the denture base or around the teethpockets. The system or a user of the system is able to identify areas onthe digital model that may be able to be thinner without jeopardizingstructural integrity. The system can perform finite element analysis orother design on the fly techniques to determine the optimum design forthe denture base and the denture teeth.

In a preferred embodiment, once the anatomical (including aesthetic andfunctional features) have been formed in the digital denture model, thedenture teeth are selected or fabricated, the denture base isfabricated. The teeth are temporarily installed in the denture base tocreate a try-in denture. The try-in denture is then shipped to thedentist for a patient try-in. If the fit is not satisfactory, then thedenture is used as a secondary impression tray and new impressions arecreated and scanned. These scans along with any additional changes inmeasurement data are put back into the system to render an improveddigital denture model. New denture teeth are selected or fabricatedbased on this improved model, if necessary. The teeth are once againtemporarily installed and the improved try-in denture is ready foranother try-in with the patient.

The system of a preferred embodiment may also be to select and designareas where implant supports may be placed. These implant supports couldbe for example a bar or a housing. The placement could be a optimizationprocess between the anatomical landmarks captured by a CT scan (bonedensity and shape) and the aesthetics and functional aspects of thedenture.

This process is continued until the patient and dentist are satisfiedwith the denture. Once the denture has been deemed satisfactory, thedenture is shipped back to the lab so that the teeth can be permanentlyinstalled and the final finish and polish procedures are performed. Thefinished denture is then shipped to the dentist for the patient finalinsert and acceptance.

These and other features of the claimed inventions will be evident fromthe ensuing detailed description of preferred embodiments, from thedrawings and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a workflow diagram of an embodiment of the presentinvention.

FIG. 2 is an inner and outer scan of a bite impression.

FIG. 3 is a rendition of a three dimensional model of a denture base.

FIG. 4 is an illustration of the mandibular arch.

FIG. 5 is an illustration of the maxillary arch.

FIG. 6 is an illustration of a rear perspective view of a denture baseof a preferred embodiment of the present invention.

FIG. 7 is a front perspective view of the denture base.

FIG. 8 is top perspective view of the denture base.

FIG. 9 is a rear view of the denture base.

FIG. 10 is a top view of the lower denture base.

FIG. 11 is an illustration of a denture base with implant housings.

DETAILED DESCRIPTION

The present invention provides systems and process for the fabricationof dentures that correspond to anatomical landmarks of the patient.Descriptive embodiments are provided before for explanatory purposes. Itis to be expressly understood that the present invention is not belimited to these descriptive embodiments. Other embodiments areconsidered to be within the scope of the present invention, includingwithout limitation the use of the present invention for otherapplications, such as denture duplication, dental implants, and otherdental and orthodontic applications. The descriptions below discuss thesystems of the present invention as used in dental labs, but it is to beexpressly understood that these systems could also be implemented in thedentist office or through a network allowing interaction between thedentist and the dental lab through the systems. The processes andsystems of the present invention may also be used in combination withall or parts of the following applications, entitled System andProcesses for Optimization for Dentures, Ser. No. 12/939,141; System andProcess for Duplication of Dentures, Ser. No. 12/939,136; CombinationTool for Anatomical Measurement for Denture Manufacture, Ser. No.13/249,210; and Removable Handle for Use with Dentures, Ser. No.12/939,143; all of which are hereby incorporated herein by reference.

Overview

The terms denture base generally refers to the part of a denture thatfits the oral mucosa of the basal seat, restores the normal contours ofthe soft tissues of the dentulous mouth, and supports the artificialteeth. The term denture refers to the denture base with the artificialteeth attached. The term anatomical landmarks refers to the structureson the anatomy of the wearer that define the periphery of the denture.The term anatomical features includes the features corresponding to theanatomical landmarks of the wearer as well as functional and aestheticfeatures that are created in the denture.

The system of a preferred embodiment uses a process whereby a truereplication of the patient's jaw structure is created in a digital threedimensional model. This true replication is then used to preciselylocate and/or copy the anatomical landmarks of the patient for use infabricating a denture base for use in a denture for the individualpatient.

In one preferred embodiment as described in the flow chart of FIG. 1,scans of the patient's bite impressions are taken and a number ofmeasurements from the patient on their initial visit. These measurementsare based on the anatomical features of the patient. The dentist mayalso provide information regarding to the selection of the teeth. Thisinformation is transmitted to the dental lab where the system creates adigital three dimensional model of the patient's jaw structure from thescans and from the measurements. It is to be expressly understood thatother methods of creating a digital three dimensional model of the jawstructure may be used as well. The process described herein is only oneembodiment for doing so.

Once the digital model has been created, denture teeth are selected froma library or fabricated directly for that digital model. This can bebased on using a library and selecting the best denture teeth, throughan optimization process as described in the above identified co pendingapplication, or through another process.

The system of a preferred embodiment of the present invention eithercreates a digital denture base or modifies an existing digital denturebase to create the best fit in the patient by precise use of theanatomical landmarks of the patient. These include locating the ideallocation of the post dam, locating and forming the notches for thelabial and buccal frenums, creating the idealized margins along thebuccal reflection, creating the idealized gum line and root structures,creating a true copy of the patient's palatial rugae and duplicatingthat structure on the denture base, locating the soft tissue lines ofthe patients mouth, locating areas for dental implant structures and anyother features that are useful or desirable from either a functional oraesthetic standpoint.

A description of one process and system for preforming the claimedinventions is described below. In this preferred embodiment, a digitalthree dimensional model of the patient's mouth and jaw structure iscreated from scanned bite impressions and from precise measurements ofthe anatomical features of the patient.

Measurement Process

The dentist obtains data regarding several anatomical landmarks of thepatient to send to the dental lab. First, the dentist takes the biteimpressions. This can be done by using an upper bite impression tray, alower bite impression tray and a centric relationship tray or a triplebite impression tray that simultaneously takes upper and lower andcentric bite impressions. The resulting bite impressions are digitallyscanned as shown in FIG. 2 and transmitted to the lab or directly intothe system. The bite impressions provide the bite registration, theprepared area and the opposing teeth. Alternatively, or in conjunctionwith this process, an intraoral digital scanning may be done.

The dentist also takes additional measurements of anatomical features ofthe patient. These include, without limitation, the vertical heightrelation to the upper and lower bite alignment; the lip support of thepatient; the smile line of the patient; the centric relationship of thepatient; and the midline measurement. Other measurements may be taken aswell.

The lip line measurement is intended to provide a measurement of theupper lip from the anterior papilla at rest. This is traditionallymeasured by a papillameter which consist of a vestibule shield, incisivepapilla rest and an vertical handle with measurement increments.

The smile line measurement can also be determined by the papillameter.The device is inserted into position and the patient is requested tosmile so that the lip line at that position from the anterior papillacan be measured.

The midline is determined from typically from the existing intraoralanatomic structures, usually the maxillary anterior labial frenum.

The vertical height dimension is typically determined from measurementstaken from nose and chin reference points. Measurements of the verticalheight are taken at rest and of the vertical dimension of occlusion.

A centric tray is commonly used to take a double arch registration torecord vertical and centric jaw registration.

The occlusal plane is an orientation of the position of an imaginaryocclusal plane which theoretically touches the incisal edges of theincisors and tips of the occluding surface of the posterior teeth. Anormal occlusal plane extends parallel to a line drawn from the tragusof the ear to the ala of the nose and parallel to the interpupillaryline (Kamper's Line). This ensures that the patient will not dislodgethe lower denture, particularly while eating and not bite the lateralborders of the tongue. Tools for measuring the occlusal plane typicallyinclude a thin flat plane have a curved bite piece and a pair oflaterally and distally extending wings projecting from the bite piece.

There are individual tools for each of these measurements. A single toolfor obtaining all of these measurements is disclosed in application Ser.No. 13/249,210 entitled Combination Tool for Anatomical Measurement forDenture Manufacture, and is incorporated by reference herein above. In apreferred embodiment of the present invention, this tool is used tosupply the necessary measurements for the optimization process fordesigning a denture mold.

The dentist also selects the teeth to be fitted into the denture base.Typically, the dentist will use a facial meter, anterior tooth selectionguide and a library catalog to determine the appropriate teeth. Othermethods may be used as well along with the determination of theappropriate shading of the teeth.

The scan, measurements and teeth selection are then transmitted to thedental lab or directly into the system

System

The scanned images 12, 14 of the bite impressions and the measurementsare then transmitted into a system that will process this information tocreate the digital three dimensional model. Systems for creating suchdigital three dimensional models are disclosed in U.S. Pat. No.6,616,444, assigned to Ormco Corporation and patents relating to thatpatent, U.S. Pat. No. 6,851,949, assigned to OraMetrix, Inc. and patentsrelating to that patent; and U.S. Pat. No. 7,433,810, assigned to AlignTechnology, Inc. and patents relating to that patent, all of the abovecited patents and patents and published patent applications relating tothem are incorporated herein by reference. These systems are disclosedfor use with orthodontic appliances. The present invention takes theinformation from these systems and utilizes the additional informationdescribed above in regard to the measurements of the patient's anatomyand impressions to create a digital model 20 as shown in FIG. 3 for usewith creating and optimizing a denture base.

The system of a preferred embodiment further includes the capability touniquely distinguish certain anatomical landmarks of the patient fromthis digital model. These landmarks are used to create features that areregistered to ensure their incorporation into the digital model of adenture base from which a denture base is fabricated. The anatomicallandmarks of the mandibular arch, as shown in FIG. 4 and of themaxillary arch as shown in FIG. 5 are critical for the proper fit of thedenture.

One anatomical landmark that is determined preferably by the system, butalternatively by a technician using the system is the line 50 as shownin FIG. 5 between the hard and soft palates. This line is irregular anddifficult to determine precisely using current techniques. This line canbe determined from the digital model based on the pressure or density inwhich the bite impressions are formed. For example, the impression willhave a greater density at the hard palate due to the greater pressureapplied upon it compared to the pressure exerted by the soft palate whenthe patient bites down on the impression compound. The line may also bereadily noticeable simply due to this change in pressure between thepalates on the impression compound. This can show up as different colorson the digital model or simply be registered by the system. Othertechniques may be used as well. The system then is able to create thepost dam along that line of demarcation. This will ensure a tight sealto create a vacuum between the denture and palate to secure the denture.

Another anatomical landmark that is determined is the labial frenum 52.The precise location of the labial frenum can be registered for thecreation of the notch 72 in the denture base as shown in FIG. 7. Thebuccal frenums 54, 56 are also located and registered to create notches74, 76 in the denture base for these frenums as well. This minimizesdislocation of the denture during speech and improves the comfort, fitand aesthetics of the denture.

The buccal reflection 66 of the patient can be located as well bychanges in density due to changes in pressure on the impression compoundor simply by the change in structure of the impression. From thisprecise location of the buccal reflection, the buccal roll 59 can beformed on the denture base. Then, an undercut can be formed in thedenture base on the buccal roll. The tissue and muscles surrounding thebuccal roll will engage into the undercut to form a gripping region tofurther secure the denture.

The margin, or trim line along the buccal reflection 66, as shown inFIG. 4 can be precisely located. This reduces the time for technician tocarve or trim the denture base after molding and improves the comfort.This margin line can also be registered by the system to be includedinto the digital denture base and denture base.

The soft tissue lines are also determined from the digital model so thatthey can be registered and included into the denture base forfabricating the base. In particular, the gingival margin where the gumends on the teeth and the soft tissue surrounding the roots of the teethbelow the gum are mimicked on the denture base. These soft tissue linesare largely for aesthetic reasons but also may improve the comfort tothe patient.

The rugae 78 of the individual patient can also be uniquely copied foruse in the denture base. Each rugae is unique to an individual andaffect the speech and comfort of the individual. The rugae is also usedto identify individuals for forensic purposes. The rugae is copied onthe tissue side and mimicked on the teeth side. The rugae can also beaccentuated or diminished as needed to improve the speech or comfort ofthe patient. The rugae is registered by the system for copying into thedigital denture base.

The digital denture model can also be used to identify locations on theoptimal denture base for implant supports to be inserted. These supportscan be housings such as housings 90 shown in FIG. 11 or bars or othertypes of supports.

The digital denture model can also be used to identify areas on thedenture base which can be thinned to increase comfort while notcompromising the structural integrity of the denture base. This can bein the arch, the palatial region and around the teeth pockets. A finiteelement analysis can also be used to determine these areas.

Other features can be identified and registered by the system ifdesired. In one embodiment, denture teeth are selected from a librarythat best fits the digital denture base and modified if necessary. In analternative embodiment, the denture teeth are fabricated directly frominformation based on the digital denture base model.

Examples of a denture base with the features formed therein areillustrated in FIGS. 6-11. Denture base 70 includes a notch 72 for thelabial frenum as well as notches 74, 76 for the buccal frenum. A truerugae 78 that mirrors the patient's rugae is formed as well. Pockets 80are formed, preferably by milling or rapid prototyping, for theinstallation of the teeth. The geometry of these pockets has beencritically designed for the best occlusal fit of the teeth. Post dam 82has been formed precisely along the line of between the hard and softpalate. The margins or gum lines 84 and root structures 87 have alsobeen created as well. Critical areas have also been selected to thin thedenture base, particularly along the arch palate and teeth pockets. Anbuccal roll 86 in FIG. 8 may also be formed for engagement along thebuccal reflection 66 as well. A lower denture 100 is also shown in FIG.10.

The denture base is selected or fabricated and the teeth are temporarilyinstalled. This try-in denture is then shipped to the dentist for apatient try-in. If the fit is not satisfactory, then the denture is usedas a secondary impression tray and a new impression is created andscanned. This scan along with any additional changes in measurement datais put back into the system. A new denture base is created. The teethare once again temporarily installed and the denture is ready foranother try-in with the patient.

This process is continued until the patient and dentist are satisfiedwith the denture. Once the denture has been deemed satisfactory, thedenture is shipped back to the lab so that the teeth can be permanentlyinstalled and the final finish and polish procedures are performed. Thefinished denture is then shipped to the dentist for the patient finaltry-in and acceptance.

The system of a preferred embodiment of the present invention can beimplemented in many forms. The above description below is simply oneexample of an implementation of the system.

It is to be expressly understood that the above description is intendedonly for explanatory purposes and is not meant to limit the scope of theclaimed inventions. Other embodiments are considered to be within thescope of the claimed inventions.

What is claimed is:
 1. An onsite computer-implemented method for creating anatomical features in a denture, the method comprising: creating, a digital three dimensional model of a mouth and jaw structure of a patient; identifying anatomical landmarks of the mouth and jaw structure of the patient on the digital three dimensional model of the mouth and jaw structure of the patient; creating a digital model of a denture base that includes the identified anatomical landmarks and copying the rugae of the soft tissue on the tissue side of the denture base and mimicking the rugae on the teeth side of the denture base to create a true rugae; fabricating, a denture base that corresponds to the digital model of the denture base, wherein the system further comprises at least one of a milling machine and a rapid prototyping machine, and wherein the fabricating comprises manufacturing the denture base by the machine by at least one of milling and rapid prototyping according to the digital model; selecting denture teeth that correspond to the digital denture base model; allowing the patient to try the first denture base and selected teeth; using the first denture base as a secondary impression tray whereby secondary impressions of bite alignments are taken; fabricating a second denture base in response to the secondary impressions of bite alignments, wherein the fabricating comprises: scanning the secondary impressions of bite alignments of the mouth and jaw structure of the patient; creating a secondary digital three dimensional model of the mouth and jaw structure of the patient; identifying anatomical landmarks of the mouth and jaw structure of the patient on the secondary digital model; creating a secondary digital model of a second denture base that includes the anatomical features corresponding to the anatomical landmarks; optimizing anatomical, functional, and aesthetic features; manufacturing the second denture base by the machine by at least one of milling and rapid prototyping according to the secondary digital model; selecting denture teeth that correspond to the secondary digital model; and permanently installing the denture teeth to the second denture base to form a final denture.
 2. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying a line between the hard and soft palates; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating a post dam on the denture base model.
 3. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying a labial frenum; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating a notch based on the labial frenum.
 4. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying buccal frenums; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating notches based on the buccal frenums.
 5. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying a buccal reflection; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating an undercut adjacent a buccal roll corresponding to the buccal reflection.
 6. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying a trim line; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating a margin line along a buccal reflection.
 7. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying the rugae; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating a true rugae on the digital model.
 8. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying areas for thinning on the digital model of the denture base; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes selectively thinning the denture base on the digital model of the denture base.
 9. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying areas of soft tissue around teeth of the digital model of the mouth and jaw structure of the patient; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes creating soft tissue lines around a gum line around the teeth that simulates a root of the tooth.
 10. The method of claim 1 wherein said step of identifying the anatomical landmarks include: identifying areas for placement of implant supports on the digital model of the mouth and jaw structure of the patient; and the step of creating the digital model of the denture base that includes the identified anatomical landmarks includes locations for implant-supports on the digital model of the denture base.
 11. An onsite computer-implemented method for creating anatomical features in a denture, the method comprising: determining measurements of anatomical landmarks of a mouth and jaw structure of a patient; scanning an impression of the bite alignments of the mouth and jaw structure of the patient; creating, by a system for creating digital three dimensional models, a digital three dimensional model of the mouth and jaw structure of the patient; identifying anatomical landmarks of the mouth and jaw structure of the patient on the digital three dimensional model of the mouth and jaw structure of the patient; creating a digital model of a denture base that includes the anatomical features corresponding to the landmarks and copying the rugae of the soft tissue on the tissue side of the denture base and mimicking the rugae on the teeth side of the denture base to create a true rugae; optimizing the anatomical, functional, and aesthetic features; selecting denture teeth that corresponds to the digital model of the denture base; manufacturing a first denture base that corresponds to the digital model of the denture base, wherein the system further comprises at least one of a milling machine and a rapid prototyping machine, and wherein the manufacturing comprises fabricating the denture base by the machine by at least one of milling and rapid prototyping according to the digital model; temporarily installing the selected teeth to the first denture base; allowing the patient to try the first denture base and selected teeth; using the first denture base as a secondary impression tray whereby secondary impressions of bite alignments are taken; manufacturing a second denture base in response to the secondary impressions of bite alignments, wherein the manufacturing comprises: scanning the secondary impressions of bite alignments of the patient; creating a secondary digital three dimensional model of the mouth and jaw structure of the patient; identifying anatomical landmarks of the patient on the secondary digital model of the mouth and jaw structure of the patient; creating a secondary digital model of a second denture base that includes the anatomical features corresponding to the landmarks; optimizing the anatomical, functional, and aesthetic features; fabricating the second denture base by the machine by at least one of milling and rapid prototyping according to the secondary digital model; selecting denture teeth that correspond to the secondary digital model of the mouth and jaw structure of the patient; and permanently installing the denture teeth to the second denture base to form a final denture.
 12. The method of claim 11 wherein said step of determining measurements of anatomical landmarks of the mouth and jaw structure of the patient includes: determining the measurements of at least one of the following group of anatomical features: lip support, smile line, lip height, vertical height, centric jaw relationships.
 13. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying a line between the hard and soft palates; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes creating a post dam on the denture model of the denture base.
 14. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying a labial frenum; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes creating a notch based on the labial frenum.
 15. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying buccal frenums; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes creating notches based on the buccal frenums.
 16. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying a buccal reflection; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes creating an undercut adjacent a buccal roll corresponding to the buccal reflection.
 17. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying a trim line; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes creating a margin line based on the trim line.
 18. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying rugae; and the step of creating the digital model of a denture base that includes the features corresponding to the landmarks includes creating a true rugae based on the identified rugae.
 19. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying areas for thinning; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes thinning the denture base at the selected areas.
 20. The method of claim 11 wherein said step of identifying the anatomical landmarks of the mouth and jaw structure of the patient includes: identifying the areas for thinning through finite element analysis; and the step of creating the digital model of the denture base that includes the features corresponding to the landmarks includes thinning the digital model of the denture base at the selected areas.
 21. The method of claim 11, wherein permanently installing the denture teeth comprises one of: selecting best-fit denture teeth and affixing the denture teeth to the denture base; and fabricating the denture teeth by at least one of: rapid prototyping, layer manufacturing, milling, and machining. 